Gait kinematics of the hip, pelvis, and trunk associated with external hip adduction moment in patients with secondary hip osteoarthritis: toward determination of the key point in gait modification
Gait kinematics of the hip, pelvis, and trunk associated with external hip adduction moment in patients with secondary hip osteoarthritis: toward determination of the key point in gait modification
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DOI：
10.1186/s12891-019-3022-1
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发表时间：
2020-01-06
影响因子：
2.3
通讯作者：
Ichihashi, Noriaki
中科院分区：
文献类型：
--
作者：
Tateuchi, Hiroshige;Akiyama, Haruhiko;Ichihashi, Noriaki
研究背景：髋关节每日累积负荷较大，是步态时髋关节外收力矩（HAM）冲动和每日步数的乘积，已被确定为与继发性髋关节骨关节炎（OA）进展相关的因素。髋关节OA患者HAM脉冲增加的原因尚未确定。本研究的目的是确定步态参数与HAM脉冲在步态继发性髋关节OA患者。方法对55例22-65岁的轻中度继发性髋关节OA患者进行横断面研究。使用三维步态分析系统测量步态过程中的HAM脉冲。为了识别与HAM脉冲相关的步态参数，进行了分层多元回归分析。第一个模型（基础模型）包括体重和站立相持续时间。第二个模型包括步态参数（步态速度;额状面中的地面反作用力[GRF];额状面中的髋关节、骨盆和躯干角度）和髋关节疼痛。结果体重和站立相持续时间可以解释HAM脉冲变异的61%。在第二个模型中，考虑到体重和站立相持续时间，髋内收角（9.4%），骨盆倾斜（6.5%），躯干倾斜（3.2%），除了GRF解释的变化，在HAM脉冲。而较大的髋内收角和骨盆倾斜摆动肢体与较大的HAM冲动，较大的躯干倾斜的立场肢体与较小的HAM冲动。结论对于髋关节过度内收、骨盆向摆动侧倾斜的患者，步态矫正可减轻髋关节负荷。
Background A larger daily cumulative hip loading, which is the product of the external hip adduction moment (HAM) impulse during gait and the number of steps per day has been identified as a factor associated with the progression of secondary hip osteoarthritis (OA). The cause of the increased HAM impulse in patients with hip OA has not been identified. The purpose of this study was to identify the gait parameters associated with HAM impulse during gait in patients with secondary hip OA. Methods Fifty-five patients (age 22-65 years) with mild-to-moderate secondary hip OA participated in this cross-sectional study. The HAM impulse during gait was measured using a three-dimensional gait analysis system. To identify the gait parameters associated with HAM impulse, hierarchical multiple regression analysis was performed. The first model (basic model) included body weight and stance phase duration. The second models included gait parameters (gait speed; ground reaction force [GRF] in frontal plane; and hip, pelvic, and trunk angle in frontal plane) and hip pain in addition to the basic model. Results Body weight and stance phase duration explained 61% of the variance in HAM impulse. In the second model, which took into account body weight and stance phase duration, hip adduction angle (9.4%), pelvic tilt (6.5%), and trunk lean (3.2%) in addition to GRF explained the variance in the HAM impulse. Whereas larger hip adduction angle and pelvic tilt toward the swing limb were associated with a larger HAM impulse, larger trunk lean toward the stance limb was associated with smaller HAM impulse. Conclusion In patients with excessive hip adduction and pelvic tilt toward the swing limb during gait, gait modification may contribute to the reduction of hip joint loading.